Multicenter analysis of gestational trophoblastic neoplasia in Turkey.

BACKGROUND: To evaluate the incidence, diagnosis and management of GTN among 28 centers in Turkey. MATERIALS AND METHODS: A retrospective study was designed to include GTN patients attending 28 centers in the 10-year period between January 2003 and May 2013. Demographical characteristics of the patients, histopathological diagnosis, the International Federation of Gynecology and Obstetrics (FIGO) anatomical and prognostic scores, use of single-agent and multi-agent chemotherapy, surgical interventions and prognosis were evaluated. RESULTS: From 2003-2013, there were 1,173,235 deliveries and 456 GTN cases at the 28 centers. The incidence was calculated to be 0.38 per 1,000 deliveries. According to the evaluated data of 364 patients, the median age at diagnosis was 31 years (range, 15-59 years). A histopathological diagnosis was present for 45.1% of the patients, and invasive mole, choriocarcinoma and PSTTs were diagnosed in 22.3% (n=81), 18.1% (n=66) and 4.7% (n=17) of the patients, respectively. Regarding final prognosis, 352 (96.7%) of the patients had remission, and 7 (1.9%) had persistence, whereas the disease was mortal for 5 (1.4%) of the patients. CONCLUSIONS: Because of the differences between countries, it is important to provide national registration systems and special clinics for the accurate diagnosis and treatment of GTN.

Occult inflammation and/or ischemia may be responsible for the false positivity of biochemical Down syndrome screening test.

OBJECTIVE: To determine the possible underlying cause of a false-positive first or second trimester biochemical Down syndrome screening test result by means of second trimester amniotic fluid cytokine level analysis. METHODS: A total of 74 consecutive patients undergoing amniocentesis for karyotype analysis at 16-20 weeks' gestation were included in this prospective age-matched case-control study. The study group (n=38) had abnormal first or second trimester screening test results and normal karyotype results, while controls (n=36) included those admitted for genetic amniocentesis for other reasons who had normal first or second trimester screening test and normal karyotype results. Four markers [interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-alpha, and ischemia-modified albumin (IMA)] were studied in amniotic fluid. RESULTS: The mean age of the women in the study and control groups was 34.0+/-5.6 and 33.6+/-7.2 years, respectively. The women in the study and control groups had similar clinical and laboratory characteristics. The mean amniotic fluid IL-6 (414.84+/-83.96 vs. 343.02+/-110.59, p=0.002) and IL-8 (377.61+/-243.31 vs. 261.90+/-201.29, p=0.029), TNF-alpha (24.91+/-5.78 vs. 21.60+/-5.55, p=0.014), and IMA (1.19+/- 0.10 vs. 1.05+/-0.12, p<0.001) values were significantly increased in the study group when compared to controls. CONCLUSION: The higher amniotic fluid cytokine and ischemia-modified albumin levels in patients with false-positive first or second trimester biochemical Down syndrome screening test may result from subclinical fetal membrane inflammation and/or ischemia.

Coexistence of Mayer-Rokitansky-Kuster-Hauser syndrome and neurofibromatosis type I.

Neurofibromatosis type 1 (NF-1) is the most frequently seen form of neurofibromatosis. The characteristic features of this disorder are café au lait macules, neurofibromas, axillary and inguinal freckling, Lisch nodules, bone lesions such as sphenoid dysplasia, and optic glioma. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rarely seen disease characterized by complete vaginal agenesis and uterine aplasia/hypoplasia. We report a case of an 18-year-old female patient who presented with complaints of brown marks, freckling, and primary amenorrhea. NF-1 and MRKH syndrome were diagnosed by physical examination and radiologic imaging. To our knowledge, this is the first report of coexistence of these rare genetic diseases in the literature.

Maternal outcome in HELLP syndrome requiring intensive care management in a Turkish hospital

CONTEXTO E OBJETIVO: Apesar do desenvolvimento de instalações terciárias de cuidado e tratamento intensivo e de técnicas avançadas de transfusão de sangue, desordens hipertensivas da gravidez são a causa principal de mortalidade materna na maioria dos países. Nosso objetivo foi determinar o resultado materno nas gravidezes complicadas pela síndrome HELLP (hemólise, enzimas hepáticas elevadas e contagem de plaquetas baixa) que exigiram cuidados intensivos. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo realizado na Karadeniz Technical University, Department of Obstetrics and Gynecology, and Department of Anaesthesiology and Reanimation, Trabzon, Turquia. MÉTODOS: 37 pacientes com a síndrome HELLP admitidas à unidade de cuidado intensivo obstétrico foram analisadas retrospectivamente entre 1992 e 2004.RESULTADOS: Todas as pacientes eram hipertensas, com escala Glasgow de coma média de 11 ± 3,96. A idade gestacional média no parto foi de 32 ± 4,09 semanas. O parto foi vaginal em 9 e por cesárea em 27 pacientes. Anestesia geral foi usada em 12 e loco-regional em 25 pacientes. Morbidades maternas incluíram a falência renal aguda (11%), coagulação intravascular disseminada (5%), edema agudo do pulmão (3%), ascite grave (11%), o derrame pleural (3%), síndrome respiratória aguda grave (11%), descolamento prematuro de placenta (11%), edema cerebral (8%) e hemorragia cerebral (40%). Todas as pacientes necessitaram de transfusão de produtos do sangue. Ocorreram 11 (30%) mortes maternas. CONCLUSÕES: Devido à alta morbidade e mortalidade maternas encontradas nas pacientes com síndrome HELLP, protocolos antenatais de acompanhamento devem ser aplicados de modo a se obter diagnóstico precoce e a de apressar a transferência para um departamento obstétrico onde a equipe de profissionais tenha perícia no campo.

Acute alterations in biochemistry, morphology and contractility of rat isolated urinary bladder via increased intra-abdominal pressure.

OBJECTIVE: To determine the acute effects of increased intra-abdominal pressure (IAP) on the biochemistry, morphology and contractility of the rat isolated urinary bladder using an experimental laparoscopy model. METHODS: We divided 24 adult female Sprague-Dawley rats into three groups. The control group (group I) was not subjected to increased IAP. In groups II and III, IAPs of 10 and 20 mm Hg, respectively, were established by carbon dioxide pneumoperitoneum for 60 min. Thirty minutes after desufflation, the rat urinary bladder dome was removed for in vitro pharmacological investigation, measurement of malondialdehyde (MDA) levels and histopathological examination. Statistical comparisons between groups were performed. RESULTS: Tissue MDA levels in groups II and III were significantly higher than in the control group. In group II, only the lamina propria was significantly damaged. However, the epithelium, lamina propria, and serosa were significantly damaged in group III. Acetylcholine potentiated contractions in both IAP groups. Increased responses to electrical field stimulation in the IAP groups were significant only in group II. CONCLUSIONS: In this experimental model, 10 and 20 mm Hg of IAP induced by pneumoperitoneum increased MDA levels and caused important changes in the morphology and contractile response of the urinary bladder.

The acute alterations in biochemistry, morphology, and contractility of rat-isolated terminal ileum via increased intra-abdominal pressure.

AIM AND SCOPE: To determine the acute effects of increased intra-abdominal pressure (IAP) on the biochemistry, morphology, and contractility of the isolated terminal ileum of rats. BACKGROUND: Laparoscopic procedures are used clinically in diagnostic and treatment modalities and experimentally as a model of ischemia-reperfusion injury induced by the elevation of IAP. Although some clinical and in vivo experimental studies investigate the results of ischemia-reperfusion injury whether induced by elevated IAP or clamping, there is no in vitro study that has investigated the acute effects of high IAP mimicked by a laparoscopic intervention in any of the intra-abdominal organs (like terminal ileum) on the basis of contractility which represents the motility. METHODS: Twenty-four adult with either sex Sprague-Dawley rats were divided into three groups. The control group (Group I) was not subjected to any IAP. In Groups II and III, an IAP of 10 and 20 mmHg, respectively, was established by carbon dioxide pneumoperitoneum for a period of 60 min. Thirty minutes after the desufflation, the terminal ileum was removed for in vitro pharmacological investigation, measurement of malondialdehyde (MDA) values, and histopathological examination. Statistical comparisons among groups were done using the Kruskal-Wallis variance analysis, with post hoc comparison performed with the Mann-Whitney U-test. RESULTS: Tissue MDA value and the damage scores of mucosa and submucosa were significantly increased in both IAP groups. The smooth muscle layer was significantly damaged only in Group III. The contractions obtained by electrical field stimulation (EFS) were inhibited in both IAP groups, and the contractions to acetylcholine were inhibited in Group III when compared to the control group. CONCLUSIONS: In conclusion, we can say that pneumoperitoneum induced IAP may inhibit contractile responses, cause structural alterations which may be related to ischemia-reperfusion injury in rat terminal ileum.

The effects of short-term raloxifene therapy on fibrinolysis markers: TAFI, tPA, and PAI-1.

BACKGROUND: Markers of fibrinolysis, thrombin-activatable fibrinolysis inhibitor (TAFI), tissue-type plasminogen activator (tPA), and plasminogen activator inhibitor-1 (PAI-1) levels were studied for the evaluation of short-term effects of raloxifene administration in postmenopausal women. METHODS: Thirty-nine postmenopausal women with osteopenia or osteoporosis were included in this prospective, controlled clinical study. Twenty-five women were given raloxifene hydrochloride (60 mg/day) plus calcium (500 mg/day). Age-matched controls (n = 14) were given only calcium. Plasma TAFI, tPA, and PAI-1 antigen levels were measured at baseline and after 3 months of treatment by commercially available ELISA kits. Variations of individuals were assessed by Wilcoxon's test. Relationship between those markers and demographic characteristics were investigated. RESULTS: Three months of raloxifene treatment was associated with a significant decrease in the plasma TAFI antigen concentrations (16% change, P < 0.01), and a significant increase in tPA antigen concentrations (25% change, P < 0.05). A significant correlation was found between baseline TAFI antigen concentrations and the duration of amenorrhea (P < 0.05; r = 0.33). CONCLUSION: We suggest that the increased risk of venous thromboembolism due to raloxifene treatment may be related to increased tPA levels, but not TAFI levels.

Primary retroperitoneal liposarcoma.

A retroperitoneal liposarcoma that marginally involved the right kidney and ovary was presented clinically as an adnexial mass in a 61-year-old woman. At laparatomy a large retroperitoneal mass in addition to the right kidney and ovary was removed totally. A well-differentiated retroperitoneal liposarcoma was detected in histological speciment. Adjuvant irradiation was given. The 5-year survival rate of retroperitoneal liposarcoma is low. Curative resection remains the main treatment for primary and recurrent liposarcomas.

Leiomyosarcoma of the Uterus Presenting with Thrombotic Thrombocytopenic Purpura.

Thrombotic thrombocytopenic purpura (TTP) typically presents with consumptive thrombocytopenia, non-immune intravascular hemolytic anemia, renal failure, various neurologic findings and fever. It is a clinical syndrome that can be associated with drugs such as ticlopidine, quinine, mitomycin C and cyclosporine, allogeneic stem cell transplantation, pregnancy, infections, autoimmune diseases and metastatic carcinoma. Here, we describe a 48-years- old women presented with full picture of TTP and diagnosed as leiomyosarcoma with further evaluation. She was successfully treated with multiple exchange transfusions and total excision of leiomyoma thereafter. As far as we know, this is the first case of leiomyosarcoma of the uterus presented with TTP. Therefore, the women with TTP, in whom no other cause can be found, should undergo a careful gynecological examination and pelvic ultrasonography should be performed.